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While we do disagree with certain of his interpretations and conclusions, we deeply appreciate his recognition of the impact of health fairs on the American health care system. Dr Berwick's article must be read with a firm understanding of the role of our health fairs in that system. Health fairs are viewed by NHSCVO as vehicles for health education and promotion, not as diagnostic centers or substitutes for examination by a physician. In this context, the emphasis in critiquing the value of health fairs should be placed not on the five participants in every 1,000 (Dr Berwick's numbers) who will have positive results in a screening test for hyperlipidemia, but on the 995 healthy participants who came for screening studies but left with a deep¬ er appreciation of their body, its needs, and their responsibility for its well-being. It is through education and motivation that a health fair accomplishes its goal, using screening tests merely as one of many tools. This is not to say that the manner in which the screening, consultation, and follow-up are structured is imma¬ terial. Dr Berwick and NHSCVO are in agreement that all screenings in all settings should be evaluated on the basis of several factors, including usefulness, accuracy, psychological effects on the participants, educa-tional value, direct and indirect cost, and public demand. We will continue the process of examining our educa¬ tional programs and screenings, and remain open to feedback and con¬ structive criticisms, such as those offered by Dr Berwick.

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